Provider Demographics
NPI:1962150524
Name:FAUST, BRIAN JACOB (DC)
Entity type:Individual
Prefix:
First Name:BRIAN
Middle Name:JACOB
Last Name:FAUST
Suffix:
Gender:M
Credentials:DC
Other - Prefix:
Other - First Name:JAKE
Other - Middle Name:
Other - Last Name:FAUST
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:DC
Mailing Address - Street 1:PO BOX 538
Mailing Address - Street 2:
Mailing Address - City:BELLVILLE
Mailing Address - State:OH
Mailing Address - Zip Code:44813-0538
Mailing Address - Country:US
Mailing Address - Phone:419-884-7314
Mailing Address - Fax:
Practice Address - Street 1:201 E MAIN ST
Practice Address - Street 2:
Practice Address - City:LEXINGTON
Practice Address - State:OH
Practice Address - Zip Code:44904-1366
Practice Address - Country:US
Practice Address - Phone:419-884-7314
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2022-03-14
Last Update Date:2022-03-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OHDC-05082111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor